RENAL DISEASE PROGRAM - PART D
If I have CRDP, why should I enroll in Part D?
Under Federal regulations, Medicare beneficiaries have
only 63 days to enroll in creditable coverage or Medicare Part D from the day
they are initially eligible for Part D. Those who are
eligible and do not enroll timely are assessed a lifetime monthly late
penalty by Medicare.
Creditable coverage is defined as coverage as good as or
better than Medicare Part D. Since CRDP drug coverage is not deemed as
creditable coverage by Medicare, CRDP cardholders who
become Medicare eligible must elect Medicare Part D or creditable coverage.
CRDP cardholders who do not enroll in Medicare Part D
timely, may be assessed a lifetime late enrollment penalty.
Enrolling in Part D may also help to reduce out-of-pocket
costs for medications not currently covered by CRDP. Individuals who are
Medicare eligible and enroll in Medicare Part D helps
incur less costs to CRDP. Lessening the CRDP’s portion of drug costs helps to
expand benefits in the future.
Can I decide not to enroll in Part D at all?
Yes. Enrollment in Medicare Part D is voluntary if you
are enrolled in CRDP. If you are in CRDP and you choose not to enroll in Part
CRDP will continue to pay for your medications. However,
if you lose CRDP coverage and need to enroll in Medicare Part D or if you
decide to enroll in Part D later, you may be assessed a
higher monthly premium because CRDP is not considered "creditable
Did all CRDP cardholders get selected for Part D?
No. CRDP enrolled cardholders into Part D if they were
eligible for Part D coverage and had not yet enrolled in Part D on their own.
Cardholders who have creditable coverage through an
employer or retiree plan or who are enrolled in a Medicare Advantage plan
(Medicare HMO) should not have been enrolled by CRDP
into a stand-alone Part D plan. If you are a CRDP cardholder whose
enrollment into a Part D plan negatively affected any
other healthcare coverage that you have, please contact the program at 1-800-
How do I know if CRDP is enrolling me in Medicare Part D?
If CRDP enrolls you into a Part D plan, you will receive
a letter from the program telling you the name of the Medicare Part D plan that
they have selected for you. If you did not receive a
letter, you would not have been auto-enrolled into a Part D plan by the CRDP.
If you are enrolled in a Medicare Advantage plan (HMO)
or have creditable coverage through your employer-sponsored retiree plan,
CRDP will not enroll you into a stand-alone Part D plan.
If CRDP enrolled you in Part D, it would disrupt your
health insurance or cause you to lose coverage completely. If you have either
these coverages, you should contact your insurance
company for further instructions on whether you should enroll in Part D.
I have not received any letter or other information from CRDP
about how they will work with my Part D plan. Does that mean that I
will not get any help from CRDP with Part D costs?
All Medicare Part D plans are required to coordinate
with CRDP for the purposes of prescription drug claims. Ultimately,
for Medicare Part D covered drugs that are also on the
CRDP formulary will result in the lowest out-of-pocket expense at the pharmacy.
All Medicare Part D plans are NOT required to coordinate
with CRDP for the purposes of premiums. To maximize the help received
with premiums, each year, CRDP submits premium
assistance agreements to Part D plans in Pennsylvania. Part D plans that meet
requirements of the Commonwealth subsequently become
premium assistance plans. The premium assistance plans are published on
a list of Pennsylvania premium assistance plans. CRDP
cardholders enrolled in a Medicare Part D plan without a premium assistance
agreement will be responsible for paying the monthly
Medicare Part D premium or may opt to switch plans any time throughout the
year due to the lack of premium assistance.
If you are a CRDP cardholder enrolled in a Part D plan
that is not a CRDP partner plan, CRDP will provide coverage during any
deductible or coverage gap phases and payment for
co-payment differences between the plan and CRDP. However, CRDP is not able to
provide premium payments unless a premium payment
agreement has been made between the non-partner plan and the
If you would like to switch to a CRDP premium assistance
plan in order to get the most help with your Part D costs, you can contact the
program at 1-800-225-7223.
I had already joined a Part D plan on my own. Will the CRDP help
me with the costs of that coverage?
The CRDP intends to help all cardholders with the costs
of Part D coverage; however, the timeframe for when this help begins will
differ depending on what Part D plan you currently have.
And, ultimately, some Part D plans may not agree to work with CRDP.
When did CRDP start working with Part D?
CRDP began working with Part D effective October 1,
2006. Using your Part D identification card along with your CRDP card at the
pharmacy will help provide cardholders with the lowest
out-of-pocket expense at the pharmacy.
How will pharmacies know about these changes?
CRDP staff has informed pharmacies about how the CRDP
works with Part D. We continue to share information with the pharmacy
network on a regular basis.
I am not currently enrolled in CRDP. If I enroll in the program,
will I be automatically enrolled in Part D?
If you are enrolled in a Part D plan when you enroll in
CRDP, you can stay enrolled in the Part D plan. If it is not a CRDP premium
assistance plan, we may not be able to help with all the
Part D costs.
If you are eligible for Medicare and not enrolled in
Part D when you enroll in CRDP, we will not assign you to a Part D plan
upon enrolling in CRDP. CRDP is a State Pharmaceutical
Assistance Program (SPAP). As an SPAP, CRDP cardholders have two
enrollment periods for Medicare Part D - an annual
enrollment period and a special enrollment period. Contact CRDP for more
information at 1-800-225-7223.
Who will pay the Part D premium?
The CRDP Program will pay the Part D premiums for CRDP
cardholders up to the regional benchmark, which is $39.45 in
2017. However, in order for this to occur, the CRDP must
execute agreements with the Part D plans. If you are enrolled in a plan that is
not a premium assistance plan, then CRDP will not be
able to pay towards your monthly Medicare Part D premium cost.
If I am enrolled in Part D, will I still use my CRDP Card?
Yes, show both cards at the pharmacy. This will tell
your pharmacist to bill your Part D plan first, and bill CRDP second. It will
your pharmacist that you are entitled to all of the
drugs that are available under CRDP.
Will my co-payments be higher with CRDP and Medicare Part D?
No. Enrolling in Part D and CRDP will help you receive
lower out-of-pocket expense for drugs not covered by CRDP. In order to
maximize your lowest out-of-pocket expense, present your
Part D and CRDP cards to your pharmacist and make sure that the
pharmacy can bill both programs for your prescription
medications. If you are taking medications that are not covered by the CRDP,
you will pay your Part D plan's co-pay for those drugs.
If there is any confusion at your pharmacy, call the program's toll free number
1-800-225-7223 while you are at the pharmacy.
Suppose my Part D plan charges lower co-payments than CRDP. What
You will pay the lower co-payments.
Many Part D plans stop their coverage after you reach a certain
dollar limit. This is sometimes called the doughnut hole. How does
this work under Medicare Part D and CRDP?
The CRDP will fill in the gaps, so that you can continue
to get your drugs just as you did under CRDP. However, if you are taking
medications that are not covered by CRDP, then you will
be responsible for the full cost of the medication that is charged to you by
your Part D plan during the doughnut hole period, unless
you have other prescription benefits that can be used during this time.
Suppose my Part D plan does not cover all of the drugs that CRDP
The CRDP program will automatically pay for drugs that
your Part D plan won't cover, so long as these are drugs covered by CRDP.
Can I go to any pharmacy I choose if I am in CRDP and Medicare
No, you must use the pharmacies that are in your Part D
plan's network and participating with CRDP. If you decide to change
pharmacies, check with your new pharmacy to make sure
they participate in your Part D plan and CRDP.
If my Part D plan offers a mail-order service, can I use it?
Yes, but the mail-order pharmacy must participate with
CRDP in order for the program to help pay for your extra copayments. Also,
since you will be ordering a three-month supply of your
drug by mail, you will be paying up to three CRDP copayments at once. For
example, a CRDP cardholder would pay $18 for a 90-day
supply of generic medications.
Where can I get a list of the mail-order pharmacies that I can
CRDP cardholders enrolled in Part D use the pharmacies
that participate in the Part D plan's pharmacy network. If your Part D plan
offers mail-order services, the plan has information for
you regarding these pharmacies in their Welcome Kit and enrollment
How did the program decide which Part D plan to enroll me in?
We looked at the drugs that you take that are covered by
the CRDP and tried to match you up with a partner Part D plan that covers
those medications. We also checked to make sure that
your pharmacy participates in that plan.
Which Part D plans have partnered with CRDP? What are the
premiums for each plan?
Silverscript Choice Plan
WellCare Classic Plan
Are these the only plans that I can enroll in?
No, but these plans have signed agreements with the
program and that makes it easier for CRDP to coordinate with them and avoid
confusion. Enrolling in a premium assistance plan
guarantees that you get the most help with your Part D plan costs.
Where can I get more information about the Part D plans
available in PA?
Information about premiums, participating pharmacies and
covered drugs for Part D plans operating in Pennsylvania is available by
calling 1-800-Medicare (1-800-633-4227 or 1-877-486-2048
(TTY)) or on the web at: www.medicare.gov.
Can I pick a different plan from the one that the program has
chosen for me?
Yes. During the Open Enrollment Period, Medicare
beneficiaries can enroll, change, or terminate their Part D plan. Towards the
each year, the CRDP program will send you information
about Part D plan options. If you would like to pick a different partner plan,
you should call 1-800-225-7223. If you want to enroll in
a Part D plan that is not one of our partner plans, you should call Medicare at
If I am already enrolled in a Part D plan and have been paying
my monthly premiums to the plan, will I still be switched over to the
Part D plan that the CRDP program picked for me?
During the Open Enrollment Period, you will receive a
letter from CRDP if you are already enrolled in Part D. The letter helps
the lowest cost partner plan option for you in the
upcoming year. You may remain in your current plan and are not required to
plans in order to remain in CRDP. You may continue to
receive premium assistance from CRDP if your plan is on the premium
What should I do if I receive a bill from my Part D plan for the
If you are enrolled in one of CRDP's partner plans, no
premium assistance should be billed to you on a monthly basis. Instead, this
monthly premium will be billed to CRDP and paid on your
If you are enrolled in one of CRDP’s non-partner plans,
you may receive up to the regional benchmark ($39.45 in 2017) towards your
monthly Medicare premium and/or late enrollment penalty.
If your monthly Part D premium and/or late enrollment penalty is over
the regional benchmark, you will be responsible for the
difference not reimbursed by CRDP.
The plan can bill a monthly late enrollment penalty if
enrollment was not performed timely into Medicare Part D.
If you receive a bill from your Part D plan that you
believe may not be your responsibility, please contact the Program at
If I am in a Medicare Advantage plan without prescription drug
coverage, do I have to change plans to enroll in Part D?
If you are in a Medicare Advantage Plan without
prescription drug coverage and you would like to enroll in Part D, you need to
your Medicare Advantage Plan to see if they offer a Part
D benefit. If they do, you should enroll through your Medicare Advantage
plan in order to minimize any disruption to your medical
care. If you are in CRDP, the program will pay the Part D premium portion for
you as long as the plan has signed a premium payment
agreement with the CRDP.
If your Medicare Advantage Plan does not offer a Part D
benefit, then you may need to join a different Medicare Advantage Plan
a different company to get Part D. Keep in mind that changing Medicare
Advantage plans may affect your choice of doctors.